Hypertension in practice: towards the year 2010

This review is based on the premise that the majority of hypertensive patients are managed by primary healthcare teams comprising both doctors and specialist nurses. It attempts to provide clinical guidance, taking into account the large number of important long-term outcome studies published since the millennium. It is now clear that clinical decisions should be made on the basis of the systolic rather than diastolic blood pressure. It is also now increasingly evident that blood pressure readings taken at home are more predictive of outcome than isolated raised readings taken in the clinic. Patients should now be encouraged to obtain their own blood pressure machine in order to provide reliable readings in a familiar nonstressed setting. The threshold for starting antihypertensive medication depends on the patients’ total cardiovascular risk, rather that just the height of the blood pressure. In particular, blood pressure should be managed aggressively in patients who have concurrent diabetes mellitus. T...